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Biomedical subjects

M F Parry

Publications and source records attributed to M F Parry.

At least 37 records · Page 2Linked to original sources

Thrombocytosis: an acute-phase reactant, not an adverse reaction to the new beta-lactam antibiotics.

Thrombocytosis has been described as an adverse drug reaction in up to 30% of patients treated with new beta-lactam antibiotics. We evaluated 350 patients with acute noninfectious conditions and infectious diseases treated with a variety of new and old agents. Results indicate that thrombocytosis is an acute-phase reactant and not an adverse reaction to any antimicrobial agent.

Anti-Bacterial Agents↗

The in-vitro activity of azlocillin: a community hospital study of 1900 clinical isolates.

The in-vitro activity of azlocillin was evaluated against 1900 fresh clinical isolates from a 320-bed community hospital. Azlocillin inhibited over 90% of Pseudomonas aeruginosa isolates at less than or equal to 16 mg/l; it was four-fold more active than ticarcillin and 8- to 16-fold more active than carbenicillin. Against members of the Enterobacteriaceae azlocillin was less active than piperacillin but still inhibited over 90% of Klebsiella, Serratia and Proteus mirabilis at achievable blood levels (less than or equal to 64 mg/l). It was the most active agent against enterococci inhibiting 80% at less than or equal to 1 mg/l. Azlocillin will be a useful addition to the antibiotic formulary of the community hospital because of its exceptional anti-pseudomonal activity.

Anti-Bacterial Agents↗

The tolerance and safety of azlocillin.

The safety of azlocillin was evaluated in 631 patients treated for urinary tract or systemic infections in U.S.A. clinical trials. The mean azlocillin dose was 260 mg/kg/day and the mean duration of treatment was 11.1 days. Twenty patients (3.2%) experienced adverse local reactions and 92 patients (14.6%) experienced adverse systemic reactions. In thirty-one instances (4.9%) they led to premature termination of therapy, but only 14 of 135 reactions were classified as severe. All adverse reactions were reversible if adequate follow-up was done. Hypersensitivity reactions, manifest by rash, fever or eosinophilia occurred in 4.4%, 0.3% and 1.1% respectively. Hypokalaemia was noted in only three instances (0.5%). Hepatotoxicity occurred in 1.7%, diarrhoea in 1.9% and leukopenia in 0.3%. Transient chest discomfort was seen on rapid infusion on three occasions. Overall, azlocillin appeared well tolerated, and had no evident unique toxicity.

Adolescent↗

The in-vitro activity of mezlocillin against community hospital isolates in comparison to other penicillins and cephalosporins.

The in-vitro activity of mezlocillin was evaluated against 1795 fresh clinical isolates at a 320-bed community hospital and compared with that of ticarcillin, piperacillin, cefoxitin, cefamandole, moxalactam, cefotaxime and cefoperazone. Only 25 isolates (1.4%) were highly resistant to mezlocillin (greater than 128 mg/l). The MIC 90 values were less than or equal to 32 mg/l for all species studied, including Klebsiella, but excluding Acinetobacter and Pseudomonas where the MIC 90 values were 64 mg/l. The anti-pseudomonal activity of mezlocillin was equivalent to that of ticarcillin but less than that of piperacillin, particularly at low MIC values. Against most members of the Enterobacteriaceae mezlocillin was more active than cefoxitin or cefamandole but was less active than moxalactam, cefotaxime or cefoperazone. Its activity against enterococci exceeded that of all other agents tested, inhibiting 82% of strains at an MIC value less than or equal to 1 mg/l. Because of its exceptionally broad spectrum, mezlocillin promises to be of value for the treatment of infections due to a wide variety of micro-organisms, and particularly for mixed infections due to Gram-negative bacilli and enterococci.

Bacteria↗

Pseudomonas aeruginosa skin infections in persons using a whirlpool in Vermont.

Four guests at a ski resort in Vermont reported contracting a characteristic papular, pustular, or vesicular rash after using the resort's whirlpool. Pseudomonas aeruginosa serotype 1, bacteriophage type 86, was isolated from a pustule on one patient, water within the whirlpool, and the whirlpool diatomaceous earth filter. This appears to be the first outbreak of dermatitis associated with P. aeruginosa serotype 1. Previous reports of whirlpool-associated dermatitis outbreaks have identified serotype 9 and 11 isolates of P aeruginosa as the causative agents.

Adult↗

Aspergillus empyema.

Aspergillus empyema occurred in a 69-year-old man six years after pneumonectomy. Exposed silk suture at the bronchial stump acted as a nidus and permitted extension of infection into the pleural space. Resolution was achieved by drainage and removal of the silk suture. The pathogenesis and management of Aspergillus empyema are reassessed in light of these findings.

Aged↗

Myeloperoxidase deficiency: prevalence and clinical significance.

Leukocyte differential counting by flow cytochemistry has shown 28 subjects with partial or complete neutrophil myeloperoxidase (MPO) deficiency in a population of about 60 000 patients screened at a general hospital. Partial (13 patients) or complete (13 patients) MPO deficiency was confirmed by examination of cytochemical stains in 26, biochemical measurement of total enzymatic activity in eight, and flow cytometry in six patients. None had apparent hematologic disorders. Only four patients had infections; of these, two had major systemic infections (one, candidiasis; one, bacteremia). In assays of leukocyte function only minor defects in killing of Staphylococcus aureus by MPO-deficient cells were noted whereas killing of Candida albicans was much more impaired. Family studies in eight patients have shown various degrees of partial or complete MPO deficiency in first-degree relatives of six. The findings indicate that the incidence of MPO deficiency is much higher than previously suspected. Although MPO appears to be necessary for killing of Candida species by neutrophils, the importance of its role in normal antibacterial defense must be re-evaluated.

Adolescent↗

Gram-negative sepsis in neonates: a nursery outbreak due to hand carriage of Citrobacter diversus.

An outbreak of Citrobacter diversus infections occurred in a newborn nursery at a 350-bed community hospital during September and October 1978. Two infants developed sepsis and meningitis and nine additional infants had asymptomatic umbilical colonization. These infants did not differ from control, noncolonized infants with respect to numerous clinical and environmental variables. Surveillance cultures failed to implicate an environmental source for the Citrobacter. However, cultures of nursery personnel identified a hand-carrier whose removal eliminated neonatal colonization with C diversus and decreased the number of isolates of certain other enteric bacteria found on umbilical stumps. Factors implicated in the perpetuation of the carrier state in this nurse included marked dermatitis from repeated hand washing and hand care practices involving the overnight use of plastic gloves and nutritive hand cream. The mode of transmission within the nursery appeared to be from nurse's hands to infant's umbilicus. Use of triple dye on umbilical stumps and chlorhexidine hand washing preparations did not eliminate this cycle. Surgical manipulation of colonized umbilical stumps may have been responsible for illness in two infants.

Carrier State↗

The epidemiology of hepatitis B infection in housestaff.

Ninety-nine medical and surgical house officers were prospectively evaluated during internship and residency for the development of hepatitis B virus (HBV) infection. The overall incidence of hepatitis B was 10.2% per year. Eighty-six percent of episodes were subclinical. The greatest risk factor appeared to be frequent hand-to-mouth activity such as smoking or licking requisition labels. The presence of a hemodialysis or transplantation unit may be an additional institutional risk factor. HBV infection was not associated with a history of needle-sticks or contact with known antigen-positive patients. Educational efforts to minimize HBV infection should concentrate on handwashing techniques and discouragement of hand-to-mouth activity in patient care areas.

Habits↗

Therapy of serious infections with cefamandole.

Forty-four patients with serious bacterial infections were treated with cefamandole in a dose 1--2 g every four to six hours. Thirty-two patients were cured and six were markedly improved. Three of six failures were due to superinfection with cephalothin-resistant microorganisms. The over-all bacteriologic response was 80%. In 12 of 13 patients with bacteremia the blood was sterilized. Ten of 14 patients with gram-negative bacillary infections responded to treatment. Six of these were due to cephalothin-resistant microorganisms, three of which responded. Fifteen patients who were treated had a history of penicillin allergy. There were no serious reactions although skin rash did develop. Phlebitis was uncommon.

Adolescent↗

A comparative study of ticarcillin plus tobramycin versus carbenicillin plus gentamicin for the treatment of serious infections due to gram-negative bacilli.

The combination of ticarcillin plus tobramycin (TT) or carbenicillin plus gentamicin (CG) was used to treat 82 patients with severe systemic gram-negative infection in a prospective, randomized study. Pseudomonas aeruginosa was the primary pathogen in 7 (93 per cent) of these patients. Patients treated with TT responded more frequently (92 per cent or 37 of 40) than patients treated with CG (71 per cent or 30 of 42) (p is less than 0.05). This difference was primarily due to a greater response to TT in patients with pulmonary infections (93 per cent versus 68 per cent) and infections due to Pseudomonas (92 per cent versus 70 per cent). Severity of underlying disease was also an important determinant of response. Except for a greater incidence of hepatotoxicity with CG (23 per cent versus 3 per cent; p is less than 0.02), there was no difference in toxicity, colonization with drug-resistant microorganisms or superinfection between the two treatment groups. The combination of TT appears to be superior to CG for the treatment of pulmonary infections due to Pseudomonas aeruginosa.

Anti-Bacterial Agents↗